Inequalities in public funding: Are hospital-based dental services funding models in Australia logical?

The availability of hospital-based dental services across Australia varies with a number of hospitals disestablishing dental departments due to rising costs. However, the perceived costs are difficult to quantify as funding models used to capture activity are not uniform across health facilities. To investigate this the predicted funding generated using current models of activity-based funding in the provision of specialist dentistry in Australian public hospitals was examined. Using data from Fiona Stanley Hospital regarding the dental treatment for head and neck cancer patients as part of their work-up for cancer management, expected funding was estimated using the existing fee-for-service and capped-fee models currently in use. Funding estimates were based on the Department of Veterans' Affairs Fee Schedule of Dental Services and the Independent Hospital Pricing Authority's Australian Non-Admitted Care Classification. A total of 127 patients received dental treatment over 209 appointments including 17 patients who had all their remaining teeth removed. Analysis revealed the fee-for-service model generated more expected funding than the current capped-fee model, or an average of AUD$458 (USD$356) per patient. Differences in how activity was recorded resulted in 81.7% uncaptured funding between the two models. This study shows that fee-for-service models capture activity more accurately. However, this model is not used in public hospitals despite it being standard practice in stand-alone public dental clinics. As a result, hospital-based dental clinics appear to be unproductive. Further research can include developing a model that better captures both the activity undertaken as well as patient complexity.